The Patient Protection and Affordable Care Act

The Promise of Health Care Reform Primary Goal: Health Insurance Coverage for approximately 26 million Americans – over 1 million Illinoisans Right Care, Right Time, Right Setting Better Health

What This Means for Illinois 2013: 1.7 million uninsured Illinoisans By 2015: – More than 400,000 will gain coverage in the Health Insurance Marketplace – Nearly 350,000 will be covered under Medicaid

What Health Care Reform Does Establishes Health Insurance Marketplace Allows states to expand Medicaid effective January 1, 2014 – Illinois opted in under Senate Bill 26 / Public Act – signed into law July 22

Options for Consumers If you already have private insurance, Medicare, Medicaid or VA coverage – Don’t do anything If you are a legal resident under age 65, earning less than $15,302 (individual) or $31,155 (family of 4) – Enroll in Medicaid If you earn more than the above limits, up to 400% of the federal poverty level [$45,960 (individual) or $94,200 (family of 4)] – Receive financial help (premium subsidies) and buy insurance in the Health Insurance Marketplace

Health Coverage with Good Benefits Prescription drugs Hospitalization Doctor visits Preventive care/wellness services Mental health & substance abuse disorder services Pediatric services – incl. oral & vision care NO denials for pre-existing conditions

When & How Do Consumers Sign Up Health Insurance Marketplace: ILLINOIS Marketplace to be launched by Oct. 1, 2013 Open enrollment starts Oct. 1, 2013 and ends March 31, 2014 Create your own account – enter information about you and your family, including income, household size Review and compare health plans and premiums Find out if you will receive financial help with premiums Choose a plan Coverage begins as soon as Jan. 1, 2014 if you enroll by Dec. 15, 2013

When & How Do Consumers Sign Up New Illinois Medicaid Enrollment Website: ABE or Application for Benefits Eligibility URL: ABE.illinois.gov Sign up starting Oct. 1, 2013 Sign up also available on walk-in basis at Dept. of Human Services offices Coverage for newly eligible Medicaid population starts Jan. 1, 2014 BOTH Marketplace and Medicaid Can sign up online, by phone, by mail or in-person with help of “Assister” or “Navigator”

Where Consumers Can Get Help Community–based “Assisters” In-Person Counselors – outreach, education and enrollment assistance Navigators – outreach, education and enrollment assistance Certified Application Counselors (includes hospitals) All “Assisters” will help consumers apply for Insurance Marketplace coverage and Medicaid

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